INAUGURAL  DISSERTATION  Oltf  THE   DISEAS: 

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AN 


INAUGURAL  DISSERTATION 


ON 


THE  DISEASES  OF  OLD  AGE. 


AS  CONNECTED  WITH 


A    PLETHORIC    STATE 


OF 

•,AAa,a 

THE  SYSTEM. 


■ 


BY  JOHN  SCUDDER,  A.  M. 

UXMBIR  OF  TIIR  MSDICO-CHIRUIHJICAL  SOCIETY  OF  TMK 
UNIVKHSITV  OF  NEW-YORK. 


11    H      )(>HK; 

PI  I    .  I  BS    B  .     V  \N    U  INK  1,1.    AM)    WII-KV  . 

I   .mi.  r  ..r  Will  wid  Nun  Htrei  • 

181  fi 


_-— ^y^**\.„-fc^-- 


'' 


/m 


AIT 
INAUGURAL  DISSERTATION 

ON 

THE    DISEASES    OF    OLD    AGE, 

AS  CONNECTKD  WITH 

4  PLETHORIC  STATE  OF  THE  SYSTEM: 

SUBMITTED 
TO  THE  PUBLIC  EXAMINATION 


TRUSTEES  OF  THE  COLLEGE  OF  PHYSICIANS  AND  SURGEONS  OF 
THE  UNIVERSITY  OF  THE  STATE  OF  NEW- YORK, 

SAMUEL  BARD,  M,  D.  PRESIDENT, 

FOR 

The  Degree  of  Doctor  of  Medicine, 

On  the  2d  day  of  May,  181S. 


ir/ilduaj  ^l^yk.  & 


un~ 


xo 


JOSEPH  SCUDDER,  ESQ.  A.  M. 


THIS 


DISSERTATION  IS  INSCRIBED, 


A  TESTIMONY 


OF 


THE  HIGHEST  ESTEEM  AND  GRATITUDE, 


EY 


HIS  AFFECTIONATE  SON 


TO 

DR.  SAMUEL  FORMAN, 

President  of  the  New-Jersey  Medical  Society. 

Sir, 

Having  commenced  my  medical  education  under  your 
direction,  permit  me  thus  publicly  to  express  my  obligations 
as  well  for  the  instruction  received  while  under  your  care 
as  for  the  many  marks  of  friendship  you  have  manifested- 
toward  me. 

With  feelings  of  the  highest  respect 
I  am,  &.c. 

JOHN  SCUDDER. 


TO 

DAVID  HOSACK,  M.  D. 

Professor  of  Ike  Theory  and  Practice  of  Physic  and  Clinical  Medicine  in  tin. 

College  of  Physicians  and  Surgeons  of  the  University  of  the 

State  of  Nero-  York,  £c.  fyc. 

THIS 

DISSERTATION  IS  DEDICATED. 

WITH 

SENTIMENTS  OF  THE  HIGHEST  RESPECT 

FOR 

HIS  DISTINGUISHED  TALENTS  AND  PRIVATE  WORTH, 

BY 

HIS  PUPIL, 

JOHN  SCUDDER. 


TO 

JOHN  W.  FRANCIS,  M.  D. 

Professor  of  Materia  Medica  in  the  College  of  Physicians  and  Surgeons  of  the 
University  of  the  State  of  Nem-  York,  fyc.  t(C. 

THIS 

DISSERTATION  IS  INSCRIBED, 

in 

TESTIMONY 

OF  THK 

REGARD  AND  FRIENDSHIP 


THE  AUTHOR. 


AN 


INAUGURAL  DISSERTATION 


ON  THE 


DISEASES  OF  OLD  AGE,  &c, 


The  discovery  of  the  circulation  of  the  blood 
is  an  era  from  which  we  may  date  a  more  rapid 
advancement  in  medical  science  than  was  ever 
effected  from  the  time  of  Hippocrates  to  that 
of  Harvey.  During  the  long  period  intervening 
between  the  appearance  of  these  distinguished 
characters,  neither  the  ingenuity  of  anatomists, 
nor  the  speculations  of  physiologists  tended  to 
throw  much  light  upon  this  important  function 
of  the  animal  economy  ;  and,  as  physicians  were 
unacquainted  with  it,  they  could  have  no  correct 
rules  to  guide  them  in  fulfilling  some  of  the  most 
important   indications  of  cure.     The  discovery 


14 

of  Harvey,  by  dispelling,  in  a  great  measure,  the 
darkness  which  enveloped  this  part  of  anatomy, 
so  far  as  it  related  to  pathological  knowledge* 
has  rendered  the  science  of  medicine  of  greater 
utility  to  mankind,  by  augmenting  the  number, 
and  rendering  more  certain,  the  principles  of 
practice. 

But  notwithstanding  the  various  improvements 
in  the  treatment  of  disease  which  have  been  con- 
sequent upon  the  discovery  of  the  circulation, 
the  fluids  of  the  human  body  are  sources  of 
many  disorders,  the  causes  of  which  are  too 
often  overlooked,  and  which  depend  either  upon 
an  excess  of  the  circulating  mass,  or  upon  certain 
changes  which  it  may  have  undergone ;  circum- 
stances which  may  take  place  equally  in  old  age 
as  in  early  life. 

That  plethora  is  a  disease  of  advanced  life,  is 
positively  denied  by  the  generality  of  practition- 
ers, and  the  lancet  as  dogmatically  proscribed. 
Evacuations  at  this  period,  say  they,  are  abso- 
lutely and  altogether  improper;  and  were  we 
guided  by  their  arguments,  we  would  necessari- 
ly believe  such  persons  rather  the  subjects  of 


15 

inanition  than  otherwise.  But  this  is  generally 
far  from  being  the  case,  for  "  although  the  system 
may  be  debilitated  by  age,  it  should  be  recollect- 
ed that  the  secretions  are  also  impaired  from  di- 
minished exercise  at  that  period  of  life,  and  that 
an  accumulation  takes  place  in  the  larger  vessels, 
rspecially  in  the  venous  system."* 

In  addition  to  this,  the  degree  of  appetite 
which  belongs  to  old  age,  the  quality  of  the  food 
taken,  and  the  sedentary  habit  which  is  generally 
connected  with  it,  all  concur  to  produce  that  state 
of  the  system  which  requires  blood  letting ;  and 
again  this  "  increase  of  appetite  in  old  people, 
their  inability  to  use  sufficient  exercise,  whereby 
the  blood  vessels  become  relaxed,  plethoric,  and 
excitable,  and,  above  all,  the  translation  of  the 
strength  of  the  muscles  to  the  arteries,  and  of 
plethora  to  the  veins,  all  indicate  bleeding  to  be 
more  necessary  in  equal  circumstances  in  old 
than  in  middle-aged  people,  f 

*  Vide  Hoback  and  Francis'  Amcr.  Med.  and  PhiloB. 
Register,  vol  4. 
■}•  Ri  on'*  Enquiries,  vol.  I 


16 

It  is  supposed  that  the  veins  in  youth  are 
stronger  than  the  arteries ;  but  that  the  latter, 
in  consequence  of  the  distention  and  pressure 
they  undergo  from  the  action  of  the  heart,  be- 
come of  increased  strength  and  thickness,  and 
even  more  dense  than  the  veins  themselves. 
Hence  venous  plethora  more  particularly  takes 
place,  as  is  manifested  by  the  appearance  of  the 
veins,  which  become  larger,  more  relaxed,  and, 
consequently,  more  replete  with  blood,  as  per- 
sons advance  in  life. 

In  addition  to  the  reasons  mentioned  we  may 
observe,  that  in  advanced  life,  the  symptoms  of 
plethora  are  particularly  manifested  by  an  inor- 
dinate pulsation  in  the  arteries,  dulness,  disincli- 
nation to  motion,  propensity  to  sleep,  by  a  heavy 
disagreeable  weight,  and  sense  of  stricture  about 
the  prsecordia.  The  extreme  vessels  frequent- 
ly become  reddened;  cephalalgia,  an  inabili- 
ty to  articulate  distinctly,  numbness  in  the 
extremities,  dizziness,  and  vertigo  take  place. 
The  pulse  is  "  sometimes  strong  and  hard ;  but 
more  frequently  obscure  or  oppressed,  and  often 


17 

apparently  weak  and  low:"*  but  if  we  have  re- 
course to    the  method  recommended  by  Mr. 
Bromfield,  of  applying  four  fingers  to  it,  and 
suddenly  raising  them  all  except  the  one  next 
to  the  patient's  hand,  the  impulse  given  will  con- 
vince us  of  its  fulness,  and  point  out  the  existence 
of  plethora.     The  mind  frequently  participate* 
in  this  diseased  condition  of  the  body ;  being  un- 
fit to  direct  itself  to  its   ordinary  pursuits.     In 
consequence  of  the  body  being  deprived  of  its  ac- 
customed exercise,  and  the  excretions  being  dimi- 
nished from  the  diminished  action  of  the  excreto- 
ry vessels,  obesity  takes  place,  which  is  often  fol- 
lowed by  apoplexy,  palsy,  hydrothorax,  ascites, 
and  anasarca,  which  are  only  to  be  cured  by 
early  recourse  to  depletion,  followed  by  tonics. 
Females,  after  the  cessation  of  the  menses, 
are,  caeteris  paribus,  more  subject  to  plethora 
than  the  male  sex ;   and  if  we  do  not  have  re- 
course to  depletion  when  the  symptoms,  such 
as  vertigo,  numbness,  and  an  oppressed  state  of 
the  lungs,  resembling  asthma,  indicate  such  ple- 
thora, a  foundation  will  frequently  be  laid  for 


'  Dtckmak  on  the  Pathology  of  the  Human  Fluids. 


many  of  the  diseases  incident  to  old  age.  Their 
complaints  at  this  time  demand  our  particular 
attention,  and  more  especially  if  there  be  the 
slightest  predisposition  to  phthisis ;  as  it  is  not  an 
uncommon  occurrence  for  the  overloaded  state 
of  the  blood  vessels  to  vent  itself  upon  the  lungs. 
When  this  occurs  blood  letting  will  be  proper, 
even  when  the  condition  of  the  system  in  other 
respects  contra-indicates  this  remedy. 

That  plethora  takes  place  in  old  age,  is  farther 
proved  by  persons  at  this  period  being  more  sub- 
ject to  gout  than  at  any  other  time  of  life,  this 
disease  being  rarely  known  to  affect  the  young ; 
and  when  it  does,  it  arises  from  intemperance 
producing  a  plethoric  state  of  the  system.  Gout 
has,  by  most  physicians,  been  considered  as  inde- 
pendent of  plethora;  but  the  authorities  of 
Sydenham,  Rush,  and  Hamilton,  (the  last  of 
whom,  himself  having  been  the  subject  of  it,  had 
a  fair  opportunity  of  witnessing  the  good  ef- 
fects of  the  plan  he  recommends,*)  have  set  the 

*  Vide  Letters  on  the  causes  and  treatment  of  Gout  Also 
extracts  from  the  work  published  in  the  Edinburgh  Med.  and 
Surg.  Journal,  vol.  6.  p.  361. 


19 

question  for  ever  at  rest,  and  satisfactorily  prov- 
ed that  it  arises  in  ninety-nine  cases  out  of  a  hun- 
dred, from  this  state  of  the  system. 

To  the  celebrated  authorities  just  mentioned, 
I  may  here  add  that  of  my  preceptor,  Dr. 
Hosack,  whose  pathological  reasoning  on  this 
subject,  and  the  issue  of  the  practice  resulting 
therefrom,  are  strong  corroborating  circum- 
stances in  favour  of  the  opinion,  that  gout  is  a 
disease  of  plethora.* 

The  causes  of  gout  prove  it  to  depend  on 
plethora.  It  is  rarely  known  to  attack  those  in 
the  humble  walks  of  life,  where  a  scanty  pit- 
tance only  is  procured,  and  this  by  severe  bodi- 
ly exercise,  the  effect  of  which  is  to  keep  the 
excretions  of  the  body  constantly  open.  On 
the  contrary,  it  affects  those  of  sedentary  ha- 
bits; those  who  are  indolent,  who  indulge  freely 
in  animal  food,  and  the  condiments  of  the  table ; 
and  who,  at  the  same  time,  partake  largely  of 

*  American  Med.  and  Philos.  Register,  vol.  4.  MS.  note* 
on  Hosack's  Lectures  on  the  Theory  and  Practice  of  Phy- 
sic and  Clinical  Medicine,  delivered  in  the  University  of  the 
State  of  New-York. 


20 

spirituous  and  vinous  liquors,  particularly  acid 
wines,  which  not  only  replete  the  blood  vessels, 
but  debilitate  the  system.  It  was  owing  to  the 
use  of  the  latter,  that  this  disease  was  observed 
by  Sennertus  to  be  endemic  in  Moravia.* 

Gout  seldom  attacks  females  who  live  tempe- 
rately; and  when  it  does,  it  usually  appears 
after  the  cessation  of  the  menses.  This  was  par- 
ticularly observed  by  Hippocrates  ;f  and  this  it 
might  readily  be  anticipated  would  be  the  case, 
as  by  this  discharge,  that  plethora,  of  the  sys- 
tem, which  takes  place  after  its  cessation,  is  pre- 
vented. 

Gout  is  usually  considered  as  a  disease  of  de- 
bility, and  doubtless  debility  is  produced  from 
the  long  continued  plethora,  which  the  applica- 
tion of  fresh  stimuli  is  constantly  increasing. 
The  equilibrium  between  the  solids  and  fluids 


*  Arthiidem  in  Moravia  esse  endemiam,  ob  acrimoniam 
acidam  et  austeram  hujus  loci  vinis,  prse  caeteris  inditam  : 
Tract,  de  Arthride,  cap.  2. 

f  Tuvn  a'tt  woia.'y^ix  h  jW»  t*  &ttsva,p.mitt.  tturt  »  \%\iir*,      Aph.   29. 

sect.  6. 


21 

is  gradually  destroyed,  and  the  fluids  being  dis- 
proportioned  to  the  strength  of  the  solids,  the 
disease  vents  itself  upon  the  weakest  parts,  pro- 
ducing that  violent  pain  and  inflammation 
which  always  attend  this  affection.  But  this  is 
no  argument  against  the  use  of  bloodletting; 
for  this  remedy,  as  remarked  by  Dr.  Rush,  "  is 
sometimes  indicated  in  a  larger  quantity  in 
weakly  than  in  robust  people,  by  the  plethora 
which  is  more  easily  induced  in  their  relaxed 
and  yielding  blood  vessels.  Thus  it  is  more  ne- 
cessary to  throw  overboard  a  large  part  of  the 
cargo  of  an  old  and  leaky  vessel  in  a  storm,  than 
of  a  new  and  strong  one." 

The  termination  of  gout  proves  it  to  be  a  dis- 
ease of  plethora.  When  it  goes  off*,  after  a  short 
attack,  the  patient  falls  into  a  gentle  sweat,*  and 
this  by  relieving  the  surcharged  vessels  from 
their  distention  procures  relief.  Wintringham 
lias  attributed  the  case  procured,  solely  to  the 


*  Btutorea per  cutis  glanriulas  erumpunt,  ct  placidus  som- 
_to  solatium,  el  quietum  addueii  Wwtrim&ham,  dc 
igra  i»  n 


22 

diminution  of  plethora  in  the  part.  "  Glandula- 
rum  omnium  cutanearum  orificia  antea  diminuta 
augebuntur,  et  larga  materiae  perspirabilis  copia 
ejicietur;  unde  diminuta  quantitate  liquidi  in 
omnibus  vasis  ultimis,  liberius  per  ea  transibet 
liquidum,  et  canales  non  adeo  infarcientur,  nee 
aequae  ultra  tonum  distendentur,  et  per  conse- 
quens  ulterius  diminuetur  dolor,  et  fiet  remissio 
symptomatum,  sive  cessabit  paroxysimus  parti- 
cularism"* 

Depositions  of  earthy  matter  also  occur  from 
the  plethora  of  the  blood  vessels,  and  these  to  the 
greatest  degree  where  the  inflammation  has  been 
greatest,  in  consequence  of  the  blood  which 
abounds  with  this  lithic  matter,  being  there  de- 
termined in  such  large  quantities,  and  the  thin- 
ner parts  being  carried  away,  while  the  thicker 
are  left  behind. 

Gout  also  terminates  in  apoplexy,  preceded, 
frequently,  by  oppression  and  swimming  in  the 
head,  with  other  symptoms  of  fulness.      Van 


*  De  Podagra,  p.  109, 


23 

Swieten  observes  that  he  could  fortel  it  by  these 
symptoms.* 

The  method  of  preventing  this  disease  also 
proves  it  to  depend  on  plethora.  This  consists 
in  abstinence  from  strong  stimulants,  confine- 
ment to  a  low  diet,  and  keeping  the  different 
excretory  vessels  pervious  It  is  owing  to  a 
free  perspiration  that  persons  so  generally  es- 
cape the  gout  in  the  summer  season;  and  if 
exercise  be  added,  it  gives  tone  to  the  system, 
and  renders  it  less  liable  to  a  succeeding  attack. 
Van  Swieten  relates  the  case  of  a  priest  who  had 
long  suffered  with  gout,  induced  by  a  rich  living 
which  he  enjoyed ;  but  being  taken  by  the  pi- 
rates of  Barbary  and  detained  in  a  state  of  slave- 
ry for  two  years,  and  being  obliged  to  work  in 
the  gallies  with  a  very  spare  diet,  he  was  com- 
pletely and  permanently  cured. 

The  occasional  use  of  bloodletting  will  also 
prevent  this  disease,  and  even  in  those  who  will 
not  renounce  their  intemperate  habits.t 

Angina  pectoris  is  a  disease  frequently  oc- 

*  Commentariea  011  1010  Aph.  of  Boerhaave. 
\  MS.  Noteaou  Hosack'b  LectureB. 


24 

curring  in  advanced  life:  it  usually  attacks 
those  who  have  short  necks,  who  are  disposed 
to  corpulency,  and  who,  at  the  same  time,  are 
of  inactive  or  sedentary  habits.  It  is  attended 
with  great  anxiety,  giddiness,  and  numbness  of 
the  extremities,  violent  palpitations,  laborious 
breathing,  and  a  sense  of  suffocation,  pain  in  the 
region  of  the  breast  and  prsecordia ;  all  of  which 
are  symptoms  of  plethora.  Dr.  Hosack  has  re- 
marked that  all  the  cases  of  this  disorder  which 
have  come  under  his  notice,  occurred  to  persons 
of  a  full  condition  of  the  blood  vessels,  and  most 
generally  in  the  advanced  periods  of  life. 

The  morbid  changes  which  manifest  them- 
selves upon  inspection  after  death,  also  demon- 
strate, that  plethora  is  the  primary  agent  in  the 
production  of  this  disease.  See  Dr.  Bogart's 
Inaugural  Dissertation  on  Angina  Pectoris,  and 
Dr,  Dyckman's  learned  and  elaborate  Disserta- 
tion on  the  Pathology  of  the  Human  Fluids. 

Another  concuring  circumstance  is  that  blood 
letting  and  other  antiphlogistic  means  have,  in 
many  cases,  removed  this  alarming  complaint.* 

*  MS.  Notes  on  Hosack's  Lectures. 


25 

A  strongly-marked  instance  of  angina  pectoris 
in  a  subject  about  sixty-five  years  of  age,  lately 
fell  under  the  observation  of  Dr.  Francis  ;  the 
paroxysms  of  which  were  uniformly  removed  by 
copious  venesection  and  other  antiphlogistic 
means. 

Dropsy  is  a  disease  of  frequent  occurrence  in 
old  age,  and  is  often  dependent  on  increased  ex- 
halation, the  effect  of  plethora,  as  is  proved  from 
the  symptoms  of  the  disorder  and  the  state  of  the 
system  preceding  its  formation ;  but  we  by  no 
means  pretend  to  say  that  it  is  always  induced 
by  this  cause ;  on  the  contrary,  it  occasionally 
arises  from  diminished  absorption,  the  conse- 
quence of  the  debility  of  the  absorbents,  and 
instead  of  depletion  by  the  lancet,  we  must  have 
recourse  to  stimulants  and  tonics. 

Having,  as  I  trust,  shown,  that  the  diseases 
which  have  been  mentioned,  arise  frequently 
from  a  plethoric  state  of  the  system,  and  that 
plethora  exists  particularly  in  old  age ;  I  shall 
mention  a  few  cases  to  prove  that  depletion, 
instead  ef* being  disadvantageous,  has,  in  many 
instances,    been    attended    with   ^thc    greatest 


benefit,  and  has  tended  to  prolong  life.  "  I  am 
sure,"  says  Dr.  Rush,  "that  I  have  seen  many 
of  the  chronic  complaints  of  old  people  mitigated 
by  blood  letting,  and  I  have  more  than  once  seen 
it  used  with  obvious  advantage  in  their  inflam- 
matory diseases."*  Several  instances  of  the  good 
effects  of  bloodletting,  are  mentioned  by  him  in 
persons  far  advanced  in  life,  and  from  my  own 
observation  I  have  seen  it  repeatedly  used  with 
great  success  in  similar  cases.  Many  striking 
cases  might  here  be  mentioned,  calculated, 
as  I  think,  to  lessen  the  influence  of  that  too 
popular  opinion,  that  the  lancet  ought  not  to  be 
employed  in  persons  of  advanced  age ;  an  opi- 
nion the  pernicious  effects  of  which  we  have 
almost  daily  evidence  in  the  numerous  cases  of 
sudden  deaths  which  occur  in  our  city  from 
plethora,  apoplexy,  palsy,  gout,  fyc.  But  two  or 
three  cases  of  this  nature,  which  fully  show  the 
salutary  effects  of  depletion,  and  which  have 
recently  occurred  in  the  practice  of  the  writer's 
preceptors,  must  suffice. 


*  Rush's  Inquiries. 


27 

Dr.  Hosack  relates  the  case  of  an  old  lady 
In  the  eighty-fifth  year  of  her  age,  who,  in 
the  course  of  three  days,  lost  by  hemorrhage 
from  the  lungs,  atthe  least  calculation,  two  quarts 
of  blood.  Very  nearly  as  much  more  was  taken 
from  her  arm  in  the  same  period  of  time,  when 
the  hemorrhage  ceased.  She  recovered  without 
any  injury  to  her  constitution,  from  the  loss  of 
blood  she  sustained."* 

In  an  old  lady  above  seventy  years  of  age,lately 
under  the  care  of  Drs.  Hosack  and  Francis, 
and  who  formerly  had  a  discharge  from  her  he- 
morrhodial  vessels,  and  had  been  subject  to  re- 
peated attacks  of  apoplexy,  in  consequence  of 
the  cessation  of  this  discharge,  the  lancet  was 
used  with  the  most  decided  success,  even  to 
the  number  of  thirty  times  in  a  year.  The 
consequence  is,  that  she  now  enjoys  a  much  bet- 
ter state  of  health  than  before,  and  the  recurrence 
of  her  fits  is  far  less  frequent. 

A  gentleman  of  this  city,   a   Mr.  C,  about 
sixty  years  old,  was  unable  to  lie  down  for  nearly 

American  Med.  ami  Philo?.  Register,  Vol.  3. 


28 

three  months,  owing  to  the  accumulation  of  wa- 
ter in  his  chest,  attended  with  cough,  laborious 
respiration,  and  diminished  secretion  of  urine,  ac- 
companied at  the  game  time  with  a  degree  of 
anasarcous  swelling  of  the  lower  extremities: 
but  by  means  of  repeated  bleeding,  and  the  com- 
bination of  calomel  and  squills,  the  symptoms 
above  mentioned  totally  disappeared ;  and  by 
the  subsequent  use  of  tonics,  he  so  far  recover- 
ed his  strength,  as  to  return  to  his  usual  active 
occupation. 

In  another  case,  in  Dr.  Hosack's  practice, 
a  patient  in  his  seventy-seventh  year,  of  a 
plethoric  habit  of  body,  was  attacked  both 
with  ascites  and  anasarca  combined,  attended 
with  all  the  characteristic  symptoms  of  those  dis- 
eases. As  these  were  induced  from  the  want  of 
exercise,  the  patient  at  the  same  time  taking  his 
customary  food  and  stimulating  drinks,  the  de- 
pleting treatment  was  deemed  expedient.  Four- 
teen ounces  of  blood  were  accordingly  taken 
from  the  arm,  followed  with  repeated  doses  of 
rhubarb  and  the  sulphate  of  potash.  During 
the  use  of  these  remedies,  his  usual  drink,  which 


29 

consisted  of  spirits  or  brandy  and  water,  as  well 
as  the  use  of  animal  food,  was  continued,  but 
in  less  quantity  than  ordinary.  The  tumor  of 
the  belly,  and  swelling  of  the  extremities,  were 
sensibly  diminished  by  the  evacuations  procured, 
and  by  the  subsequent  use  of  chalybeates,  and 
other  tonics,  his  health  was  perfectly  re-establish- 
ed.* 

Having  endeavoured  to  show  that  the  diseases 
which  have  been  mentioned,  arise  frequently 
from  a  plethoric  state  of  the  system,  and  that 
plethora  exists,  particularly  in  old  age5,' I  shall 
now  endeavour  to  prove,  that  paralysis,  which  is 
generally  considered  as  a  disease  of  debility,  also 
frequently  arises  from  the  same  causes  as  the 
other  diseases  I  have  mentioned,  and  requires 
the  same  treatment. 

Palsy  is  a  disease  occurring  at  every  period 
of  life,  in  the  young  and  in  the  aged,  but  more 
generally  in  the  latter,  and  is  divided  into  three 
kind?:  I.  Hemiplegia,  where  the  whole  of  the 
muscles  on  one  side  of  the  bodv  are  afFeeted. 


*  H<.-  *<  k's  Quarterly  Report  of  the  Diseases  of  the  city 
of  New- York,  In  American  Med.  and  PhiloB.  Register,  vol.  8. 

4 


36 

2.  Paraplegia,  where  the  lower  half  of  the 
body  only  is  affected. 

3,  Partialis,  which  usually  affects  the  head 
and  extremities,  but  is  exclusively  confined  to  no 
particular  part. 

With  respect  to  paralysis,  produced  by  the 
poison  of  mercury,  lead,  and  arsenic,  by  pressure 
on  the  nerves,  by  tumors,  by  distortions  of  the 
spine,  by  the  "  thickening  of  the  ligaments  that 
connect  the  vertebrae  together,"  by  fractures 
and  wounds,  we  shall  make  no  observations.  Our 
remarks  will  be  confined  more  particularly  to 
that  kind  which  arises  from  plethora  of  the 
blood  vessels,  adding,  at  the  same  time,  a  few  on 
that  species  which  proceeds  from  debility. 

Plethora  producing  palsy,  arises  from  a  va- 
riety of  causes.  In  young  persons  of  the  san- 
guine temperament,  where  there  is  generally  a 
large  quantity  of  circulating  fluids,  the  attack 
is  frequent.  In  old  age,  those  usually  are  the 
subjects  of  it  who  are  fat,  who  indulge  much  in 
the  use  of  animal  food  and  stimulating  drinks, 
and  who  are  inactive  in  consequence  of  the  tor- 
por which  arises  from  the  surcharged  state  of 


31 

their  blood  vessels ;  this  surcharged  state  causing 
such  pressure  as  to  destroy  the  action  of  the 
nerves,  and  produce  paralysis.  That  this  pres- 
sure does  exist,  the  symptoms  preceding  an  at- 
tack of  palsy  clearly  manifest:  these  are  numb- 
ness, coldness,  sensations  of  tingling  in  the  extre- 
mities, or  of  deadness  in  the  flesh,  numbness  and 
vertigo,  the  last  being  much  increased  by  stoop- 
ing; a  derangement  of  the  faculties  of  the  mind, 
memory,  imagination,  and  judgment;  a  depriva- 
tion of  feelings,  to  such  a  degree,  as  to  render 
the  patient  insensible  to  the  impression  of  exter- 
nal bodies ;  weakness,  and  disinclination  to  mo- 
tion ;  a  sense  of  stricture  under  the  clavicles ; 
loss  of  speech,  hearing,  seeing,  and  the  other 
symptoms  which  we  before  mentioned. 

The  resemblance  between  apoplexy  and  palsy 
is  so  great,  that  these  diseases  have  been  classed 
under  the  same  head.  Aret^eus  observes,  "  Apo- 
plexia  paraplegia,  paresis,  paralysis  omnia  gene- 
r  t  eadem  sunt,  aut  enim  motionis,  nut  tactus,  aut 
utriusque,  defectus  est."*     Van  Swieten  has 

!»<•  c;t\jih  et  signis  Morb.  duituni.  lib.  1.  cap.  2.  p.  33. 


32 

likewise  observed,  that "  as  an  apoplexy  is  a  ces- 
sation of  all  voluntary  motion,  it  may  be  consi- 
dered as  a  kind  of  general  palsy."*  They  pro- 
ceed from  the  same  cause,  are  usually  confined 
to  the  same  period  of  life,  are  preceded  by  the 
same  symptoms,  and  affect  the  same  constitu- 
tions :  "  Hemiplegia,"  says  Cltllen,  "  usually  be- 
gins with,  or  follows  a  paroxysm  of  apoplexy; 
and  when  the  hemiplegia,  after  subsisting  for 
some  time  becomes  fatal,  it  is  commonly  by 
passing  again  into  a  state  of  apoplexy."t 

From  this  great  similarity  between  the  two 
diseases,  occasional  remarks  will  be  made  on 
apoplexy,  and  should  any  particular  causes  of 
the  latter  be  mentioned,  they  are  to  be  consider- 
ed as  applicable  to  palsy. 

Palsy  often  arises  from  the  suppression  of  ac- 
customed discharges.  The  case  of  apoplexy 
which  was  formerly  mentioned,  arose  from  an 
accustomed  hemorrhoidal  discharge  being  stop- 
ped.   Eoerhaave  observes,  that  "  a  palsy  may 


*  Comment,  on  1059.  Aph.  of  Boerhaave. 
f  Cuuuen's  First  Lines. 


33 

have  for  its  cause  an  apoplexy,  a  retention  of  the 
hemorrhoids,  and  menstrua;"*  and  it  is  not  an 
uncommon  occurrence  for  this  disorder  to  super- 
vene, when  long  continued  ulcers  are  dried  up ; 
when  the  system,  from  being  deprived  of  its  cus- 
tomary discharges,  becomes  plethoric.  A  very 
valuable  life  was  not  long  since  lost  by  the  im- 
prudent stoppage  of  a  discharge  from  an  ulcer 
which  had  existed  for  many  years,  f  Facts  of 
this  kind  have  long  since  been  noticed ;  and  it 
has  been  recommended  as  a  preventive,  very  pro- 
perly, to  substitute  a  discharge  elsewhere. 

Eruptive  diseases  often  occur  at  the  decline 
of  life,  under  a  variety  of  circumstances:  they 
are  affections  which  we  cannot  repel  with  impu- 
nity, as  they  frequently  are  connected  with  a 
plethoric  state  of  the  system. 

The  celebrated  Dr.  Lettsom  supposes  that 
even  as  simple  a  disease  as  "the  prurigo  podicis, 
may  be  considered  as  a  preventive  of  other 
diseases,  having  observed  man)  persons  after  va- 
rious long  indispositions  relieved  by  its  appear- 

*Aph.   1060. 

}  MS.  Notes  on  Hosack'b  Lecture*. 


34 

ance ;"  doubtless  by  removing  the  plethora  which 
existed.  "  A  gentleman  sixty-eight  years  of  age," 
he  observes,  "  who  had  long  laboured  under  a 
disorder  of  the  chest,  attended  with  a  weak  and 
intermitting  pulse,  was  perfectly  relieved  from 
these  symptoms  by  the  prurigo  podicis.  A  fa- 
vourable termination  of  the  same  kind  happened 
in  the  case  of  a  person  who  had  been  for  upwards 
of  three  months  affected  with  vertigo,  and  other 
strong  symptoms  of  approaching  apoplexy."  He 
relates  the  case  of  "another  patient  who  was  re- 
lieved in  the  same  manner,  after  having  been 
much  debilitated  by  frequent  fits  of  the  gout ; 
but  imprudently  endeavouring  to  allay  the 
troublesome  sensation  of  itching,  by  a  strong  sa- 
turnine solution ;  he,  after  having  applied  it  a 
few  days,  suddenly  expired  in  his  chair."* 

Women,  after  the  cessation  of  the  menses,  are 
liable  to  be  affected  with  a  species  of  prurigo, 
more  especially  in  summer  or  autumn.  "  The 
skin  between  the  nates  is  rough,  papulated,  and 

*  Vide  Memoirs  of  the  Med.  Society  of  London,  vol.  5. 
Also,  Willan  on  Cutaneous  Diseases,  p.  92. 
5 


35 

sometimes  scaly.  With  this  complaint  there 
is  often  an  itching  papulous  eruption  on  the  neck, 
breast,  and  back,  a  swelling  and  inflammation  of 
the  ears,  with  a  discharge  of  matter  from  behind 
them,  and  from  the  external  meatus  auditori- 
us."  By  repelling  such  eruptions  the  greatest 
danger  is  incurred  of  producing  apoplexy,  palsy, 
and  other  diseases,  as  they  generally,  though  not 
always,  arise  from  a  plethoric  state  of  the  sys- 
tem, and  are  efforts  of  nature  to  relieve  herself. 
When  we  recollect  that  fatal  consequences,  pal- 
sies, severe  head-achs,  loss  of  sight,  and  epileptic 
fits,  have  proceeded  from  the  removal  of  that 
cutaneous  inflammation  which  so  often  affects 
the  face,  we  should  be  extremely  cautious  in  re- 
moving those  of  greater  magnitude,  unless  we 
substitute  a  discharge  in  some  other  part  of  the 
body,  as  an  outlet  to  the  superfluous  mass  of 
fluids. 

Palsy  sometimes  comes  on  instantaneously, 
without  any  previous  warning,  and  deprives  the 
patient  of  motion  and  sensation.     At  other  times 

'   Wili  an  ou  Culaneous  Diseases. 


36 

it  is  preceded  by  those  general  sympsorns  of  ful- 
ness which  have  already  been  mentioned.  When 
the  head  is  much  affected,  the  eye  and  mouth 
are  drawn  to  one  side,  the  memory  and  judg- 
ment are  impaired,  and  the  speech  is  difficult 
and  indistinct. 

When  a  person  is  first  attacked  with  palsy  we 
must  have  immediate  recourse  to  blood  letting, 
if  the  disease  has  not  been  preceded  by  great 
debility,  proportioning  the  discharge  to  the 
age,  sex,  habit,  and  temperament  of  the  patient. 
The  large  evacuations  to  which  some  have  re- 
course in  apoplexy,*  are  equally  improper  here ; 
for  it  should  be  remembered  that  the  vessels  are 
already  weakened,  torpid,  and  paralysed,  from 
over  distention,  and  that  by  subtracting  too  large 


*  In  apoplexy  we  are  directed  to  bleed  ad  deliquium ;  but 
it  should  be  remembered  that  the  brain  has  not  the  control 
of  its  vessels.  There  appears  to  be  an  extraordinary  dila- 
tation of  the  arteries,  which  large  blood  letting  does  riot  often 
diminish,  as  experience  proves ;  for  after  bleeding  to  the  ut- 
most extent,  the  pulse  has  remained  full.  "  Even  in  the  most 
athletic  habits,  such  sudden  evacuations  and  consequent  pros- 
tration of  power  of  life,  cannot  be  justified  by  reasoning  or 
practice" 


37 

a  quantity  of  blood,  they  are  left  in  such  a  state 
of  collapse  and  inaction,  that  recovery  after- 
wards is  frequently  impossible.* 

The  pulse  in  this  disease  is  sometimes  per- 
fectly natural,  sometimes  full,  frequent,  and  jerk- 
ing, without  tension.  In  either  case  we  are  to 
bleed  freely. 

Dr.  Thomas,  in  his  chapter  on  this  disease, 
condemns  the  use  of  the  lancet  in  the  strongest 
terms  in  advanced  life,  confining  it  exclusively 
to  the  young  and  plethoric:  "  When  this  dis- 
eased he  observes,  "  arises  in  a  young  person  of 
a  plethoric  habit,  comes  on  suddenly,  and  the 
head  appears  to  be  much  affected,  or  seems  to 
arise  from  the  causes  producing  apoplexy,  it  will 
be  advisable  to  take  away  some  blood;  but  in 
old  age  neither  bleeding  nor  purging  should  be 

*  The  same  observation  may  be  made  respecting  blood- 
letting during  pregnancy,  when  abortion  is  threatened.  By 
taking  away  a  sufficient  quantity  to  remove  the  oppressed 
state  of  vascular  action,  when  plethora  is  present,  our  at- 
tempts to  prevent  abortion  will  be  frequently  successful :  but 
by  bleeding  Immoderately,  such  B  degree  of  relaxation  ia 
produced,  thnt  \vc  effect  the  very  object  dreaded. 

5 


38 

resorted  to.  Where  costiveness  prevails  in  such 
habits,  it  may  be  avoided  by  some  stomachic  laxa- 
tive, such  as  the  tinctura  rhabarb.  composita."* 
Even  if  it  were  allowed  that  blood  letting  was 
generally  improper  in  the  paralysis  of  advanced 
life,  we  ought  by  no  means  to  proscribe  it  alto- 
gether, as  cases  occur  where  fatal  consequences 
may  immediately  result  from  neglecting  to  have 
recourse  to  it.  Should  we  follow  the  above  di- 
rections, though  the  vessels  be  overloaded  with 
blood,  though  the  symptoms  be  such  as  to  pre- 
dict a  state  of  apoplexy,  we  are  not  to  bleed; 
but  resort  to  stimulants  which  are  calculated  to 
replete  the  vessels  still  more,  and  to  add  greatly 
to  the  disease. 

It  is  to  be  regretted  that  the  science  of  medi- 
cine, which,  next  to  religion,  is  the  noblest,  and 
most  calculated  to  benefit  mankind,  should  ever 
be  disgraced  by  the  spirit  of  dogmatism,  and  es- 
pecially where  there  is  no  reasonable  ground 
upon  which  it  may  be  justified.  Experience  has 
proved  that  blood  letting  in  old  age  is  not  only 
useful,  but  absolutely  necessary ;  and  the  dread- 

*  Modern  Practice  of  Physic. 


39 

ful  consequences  we  have  witnessed  from  the 
neglect  of  it,  have  made  an  impression  upon  our 
minds,  which  the  unwarranted  assertions  of  a 
few  individuals  can  never  efface. 

On  the  first  attack  of  paralysis,  as  has  been 
before  said,  we  should  resort  to  blood  letting. 
This  practice  has  been  sanctioned  by  the  respec- 
table authority  of  Hunter,  who  remarks,  that 
in  palsy  "  we  ought  to  bleed  at  once  very 
largely,  till  the  patient  begins  to  show  signs  of 
recovery,  and  to  continue  it  till  he  might  begin 
to  become  faintish."*  That  this  evacuation  is 
serviceable,  is  proved  by  the  manner  in  which 
nature  sometimes  cures  the  disease,  which  is  by 
discharges  from  the  bowels.  Dr.  Thomas  himself 
lias  observed  that  it  is  sometimes  cured  by  a  diarr- 
hoea; Boerhaave,  that  nature  has  cured  the  dis- 
ease by  carrying  it  off  by  a  plentiful  and  long- 
continued  diarrhoea;  and  Van  Swieten,  that,  a 
plentiful,  and  long-continued  diarrhoea  carries 
offthe  "  morbific  matter."t  From  the  salutary  ef- 

St<-  Treatise  on  the  Blood,  pari  2.  r.hap.  I. 
f  Commentaries  on  Bokuhaave. 


40 

forts  of  nature,  important  instruction  is  to  be  ob- 
tained, as  they  teach  us  to  imitate  her  opera- 
tions. Van  Swieten  has  observed  "  that  physic 
is  never  of  greater  service  to  mankind,  than  when 
it  can  follow  the  footsteps  of  nature  in  the  cure 
of  diseases:"  and,  again,  "it  has  frequently  been 
remarked  before,  in  describing  the  cure  of  dis- 
eases, that  prudent  physicians  ought  to  consider, 
with  the  greatest  attention  possible,  those  salu- 
tary attempts  of  nature,  by  which  the  most  ob- 
stinate diseases  are  sometimes  cured ;  and  these 
being  observed  and  understood,  they  ought  to 
attempt  to  imitate  by  art  those  things  which, 
happening  spontaneously,  they  observe  to  be  of 
service." 

As  palsy  is  a  disease  so  alarming  in  its  conse- 
quences, it  is  of  the  utmost  importance  to  pre- 
vent it,  if  possible,  whenever  the  premonitory 
symptoms  point  out  its  approach.  These,  it 
may  be  repeated,  are  numbness  of  the  extremi- 
ties, vertigo,  affections  of  the  mind,  fyc.  "  Ob- 
servavi  in  pluribus,"  says  Willis,  "  quod  cum 
cerebro  primum  indisposito  mentis  hebetudine, 
et  oblivione,  et  deinde  stupiditate  et  ,««§»«■«  affice- 


41 

rentur  postea  in  paralysin,  (quod  etiam  praedi- 
cere  solebam)  incidebant."*  Even  the  numb- 
ness of  one  of  the  fingers  points  out  an  attack. 
Dr.  Hosack  relates  the  case  of  a  lady  who  was 
affected  with  this  partial  paralysis,  while  at  her 
piano,  and  first  became  sensible  of  it  by  an  ina- 
bility to  use  her  finger.  Had  she  not  been  bled, 
in  all  probability  it  would  have  terminated 
either  in  complete  paralysis,  or  in  the  loss  of  the 
functions  of  the  part. 

In  all  such  cases,  by  the  prudent  use  of  the 
lancet,  we  may  generally  prevent  the  disease; 
and  experience  having  proved  its  utility,  we 
have  no  hesitation  in  recommending  it. 

The  following  cases,  selected  from  many 
others  of  a  similar  kind,  as  they  tend  to  esta- 
blish the  correctness  of  the  doctrines  advanced, 
and  are  immediately  in  point,  it  may  not  be 
amiss  to  insert. 


De  Paralysi,  p.  145. 


42 


I. 


Edward  Swain,  aged  seventy-four,  of  the 
phlegmatic  temperament,  was,  some  time  since, 
attacked  with  fever,  accompanied  with  pain, 
for  which  he  was  bled  six  times  After  having 
recovered  he  came  into  the  Aims-House,  where 
he  had  a  renewal  of  his  fever,  and  was  again  re- 
peatedly bled.  Some  time  afterwards  he  felt  a 
numbness  in  his  left  side,  extending  down  to  his 
ankle,  with  dizziness  and  vertigo  in  his  head, 
accompanied  with  the  loss  of  smelling  and  taste. 
His  taste  was  so  much  impaired  that,  to  use  his 
own  expression,  he  "  could  not  tell  a  tablespoon 
of  salt  from  one  of  sugar."  His  complaint  caused 
him  frequently  to  fall.  He  was  on  the  stimu- 
lating treatment  when  he  came  under  my  care; 
from  which  receiving  no  benefit,  he  was  bled 
twenty  ounces,  and  was  cured  of  the  dizziness 
and  numbness  in  his  head.  Not  receiving  reliei 
for  the  numbness  in  his  extremity,  the  carb. 
ammon.  and  other  stimulants,  both  externally 
and  internally,  were  resorted  to.     He  has  since 

recovered  so  far  as  to  leave  the  house. 
5 


43 


II. 


Joseph  Miller,  aged  seventy-three,  feels  con- 
siderable numbness  in  his  head,  and  is  unable 
to  articulate  distinctly,  is  feeble,  and  cannot  walk 
as  well  as  usual.  His  mind  appears  to  partake 
of  the  diseased  condition  of  the  body,  being  in- 
capacitated to  perform  its  proper  functions.  Let 
him  be  bled.  Bleeding  has  entirely  relieved  him, 
and  he  is  as  well  as  formerly. 


III. 


C.  Williams,  aged  forty-eight,  has  felt  a  ge- 
neral numbness  for  some  time  past,  which  he 
attributes  to  his  having  caught  cold.  The  phy- 
sician, whom  he  consulted,  notwithstanding  he 
was  afflicted  with  the  sick  headach,  was  flighty, 
and  sometimes  in  danger  of  falling  when  not  sup- 
ported, condemned  the  lancet  in  the  strongest 
terms,  asserting  that  he  had  no  blood  to  lose ; 
that  he  rather  wanted  blood  than  otherwise.  He 
came  into    the    Aims-House    with    diarrhoea. 


44 

(caused,  in  all  probability,  by  plethora,)  and  was 
prescribed  for  with  little  benefit.  Complaining 
of  numbness,  and  a  sense  of  deadness  in  his  flesh, 
I  proposed  blood  letting,  to  which  he  assented. 
Next  morning,  to  use  his  own  expression,  "he 
felt  like  another  man ;"  his  numbness  being  com- 
pletely removed.  The  diarrhoea  was  soon  cured, 


IV. 


Ann  Horneke,  aged  thirty-four,  has  laboured 
under  a  discharge  from  her  bowels  for  several 
weeks,  and  taken  various  remedies  without  ef- 
fect. She  complains  of  vertiginous  affection  of 
the  head,  numbness  of  the  arms  and  feet,  with  an 
oppressive  weight  about  her  breast,  palpitation, 
fluttering,  and  such  a  degree  of  weakness  as  to 
be  unable  to  walk.  She  was  bled  freely,  which 
proved  of  material  service,  as  it  considerably  re- 
moved her  weakness,  doubtless  by  removing  that 
oppressed  state  of  action,  from  the  relaxed  con- 
dition of  the  system  which  existed,  and  restoring 
the  equilibrium  between  the  solids  and  fluids. 
Soon  afterwards,  again  feeling  numbness,  blood 


45 

letting  was  resorted  to  with  advantage,  and  she 
soon  recovered.* 

The  same  principles  which  direct  us  in  our  re- 
course to  blood  letting,  lead  also  to  the  adminis- 
tration of  purgatives :  even  in  the  most  debilitat- 
ed habits,  the  bowels  must  always  be  kept  open. 
Boerhaave  laid  particular  stress  upon  purging, 
doubtless  being  led  to  it,  by  observing  the  man- 
ner in  which  nature  sometimes  carried  off  the  dis- 
ease ;  and  experience  must  have  proved  to  him, 
during  his  extensive  practice,  that  they  were 
among  the  most  valuable  remedies.  He  recom- 
mends the  strong  hydragogue  purges  in  large 
doses,  and  repeated  several  times  successively ; 
by  means  of  which  a  plentiful  and  lasting  diar- 

*  Sometimes  blood  letting  will  not  permanently  relieve 
the  numbness  and  fulness  in  the  head,  which  are  among  the 
worst  of  the  premonitory  symptoms  of  palsy.  In  9uch 
eases  we  should  endeavour  to  make  a  determination  else- 
(There,  by  the  constant  exhibition  of  purgative  medicines, 
and  if  piles  can  be  produced,  in  all  probability,  relief 
will  be  obtained.  Blisters  should  be  applied  behind  the 
in  tin-  arms,  for  the  latne  purpose 


46 

rhoea  may  be  produced.*  In  what  cases  they 
may  be  given  to  the  extent  here  recommended* 
the  physician's  judgment  must  direct;  certain 
it  is,  that  in  many  habits  they  will  prove  valua- 
ble auxiliaries  to  the  lancet,  in  promoting  the 
cure.t 

But  the  remedy  vastly  superior  to  all  others 
after  blood  letting,  is  friction.  The  utility  of  fric- 
tion has  long  since  been  noticed,  and  certainly  it 
is  the  most  powerful  restorative  of  that  action  to 
the  nerves,  which  was  lost  by  the  over-distention 
and  plethora  of  the  blood  vessels.  The  good 
effects  of  this  remedy  were  noticed  particularly 
by  Celsus,  who  observes  that  when  a  limb  has 
become  paralytic,  it  is  strengthened  by  friction,^ 
and  even  when  the  limb  is  wasted,  it  will  be 
good'ad  alendum  id,  quod  tenue  et  infirmum 

est."§ 

— — — i ..... f .. 

*  Aphorism,  1068. 

f  A  valuable  paper  by  Dr.  Sherrill,  on  the  efficacy  of 
blood  letting  and  cathartics  in  this  disease,  may  be  found  iu 
the  14th  volume  of  the  Medical  Repository,  p.  35. 

J  Membrum  aliquod  resolutum,  ipsius  frictione  confirms* 
tur.    Lib.  2.  cap.  14. 

ft  Lib.  2.  cap.  14, 


47 

Notwithstanding  friction  was  strongly  re- 
commended, it  never  has  been  employed  with 
the  assiduity  and  attention  required.  Its  suc- 
cess is  in  proportion  to  its  early  use,  and  by 
immediate  recourse  to  it,  our  exertions,  if  suffi- 
ciently long  persisted  in,  will  almost  invariably 
terminate  in  the  restoration  of  the  parts  to  which 
it  is  applied.  It  was  remarked  to  me  by  a  gen- 
tleman, who  resided  some  length  of  time  in  the 
Aims-House  in  this  city,  that  with  the  exception 
of  one,  all  the  cases  of  paralysis  occurring  to  him, 
while  there,  were  effectually  cured  by  this  re- 
medy ;  and  of  these  there  were  only  two  who 
were  not  restored  in  the  space  of  two  hours.  In 
many  of  these  the  cure  was  perfected  without 
recourse  to  the  lancet. 

Various  external  applications  have  been  re- 
commended  for  the  purpose  of  restoring  para- 
lytic parts.  Celsus  ordered,  in  addition  to  fric- 
tion, fretting  the  skin,  or  whipping  it  with  net- 
tles* the  application  of  mustard  seed,*  and  resin- 

*  Prodest  etiain  torpentis  membri  summam  cutem  exas- 
pcrasse,  vel  urticis  cttsam,  vcl  imposito  sinapi,  sic  ut,  ubi 
rubere cceperit  corpus  ba:c  removeantur.   Lib.  3.  c.ip.  27 


ous  plasters.  Galen  made  use  of  pricking  for 
the  purpose  of  attracting  the  blood  in  greater 
quantity  to  the  part.#  For  the  same  purpose 
the  e^ot/sw,  or  beating,  was  used,  this  being  per- 
formed by  small  light  rods,  well  oiled,  with 
which  they  beat  the  wasted  part,  till  it  began  to 
grow  red  and  swell.  But  the  most  powerful 
remedy  made  use  of  was  the  whipping  with  net- 
tles, by  which  palsy  was  sometimes  suddenly 
and  perfectly  cured.  Alpinus  affirms  that  the 
Egyptians  had  even  attempted  the  cure  of  apo- 
plexy, palsy,  and  epilepsy,  successfully  by  burn- 
ing.? 

From  these  different  remedies  which  have 
been  mentioned,  we  may  conclude  the  utility  of 
stimulants  to  paralyzed  parts ;  but  it  is  not  ne- 
cessary to  have  recourse  to  a  great  variety. 
The  flesh-brush,  occasionally  impregnated  with 
aq.  ammoniae.  flowers  of  mustard,  or  cowage3 
will  answer  the  purpose. 


*  Method.  Medendi,  lib.  14.  cap.  16. 
f  Med.  Egyptior.  lib.  3.  cap.  12. 


49 

The  friction  must  steadily  be  persisted  in,  un- 
til we  can  perceive  its  good  effects,  and  for  this 
purpose  a  number  of  assistants  should  be  present 
to  relieve  each  other,  whose  efforts  are  to  be  con- 
tinued, notwithstanding  they  may  create  such 
pain  to  the  patient,  that  humanity  would  in- 
cline us  to  desist.  The  pain  of  a  few  hours  is  more 
than  counterbalanced  by  the  good  effects  which 
result  from  it;  as  we  are  enabled  to  rescue  the 
unhappy  victim  from  the  most  abject  state  in 
which  human  nature  can  exist.  The  deplorable 
condition  of  the  paralytic  can  be  best  realized 
in  those  public  charities,  where  they  are  usually 
to  be  met  with  in  great  numbers,  and  where 
they  are  doomed  to  drag  out  their  lives,  not 
only  with  the  loss  of  the  functions  of  the  body, 
but  frequently  with  derangement  of  the  faculties 
of  the  mind. 

The  following  case,  which  was  furnished  me 
by  my  friend,  Dr.  Schenck,  points  out  the  utility 
of  friction,  and  the  surprising  manner  in  which 
paralytic  parts  have  their  action  restored  by 
this  remedy. 

"  JBktfky  Lawrence,  aged  twenty-two,  was  at- 


50 

tacked  with  hemiplegia.  After  blood  letting, 
frictions  were  resorted  to,  by  means  of  a  stiff 
brush  applied  to  the  affected  parts,  and  in  one 
hour  the  parts  on  which  the  frictions  were  dili- 
gently employed,  were  restored.  At  first  her 
sensibility  was  so  far  lost,  that  the  prick  of  a  pin 
excited  no  sensation  whatever.  In  fifteen  mi- 
nutes after  the  brushes  were  applied,  she  com- 
plained of  pain  in  her  arm,  and  requested  us  to 
desist,  as  it  became  intolerable.  She  could  then 
raise  to  her  head  that  arm  which  before  hung 
motionless  by  her  side.  Her  fingers,  and  espe- 
cially the  extremities  of  them,  still  remained  in- 
sensible, which,  however,  were  restored  by  a  few 
vigorous  applications  of  the  brush.  In  the  same 
manner  her  lower  extremity  was  recovered ;  but 
not  so  quickly,  as  from  motives  of  delicacy,  she 
would  not  permit  the  frictions  to  be  employed 
by  her  male  attendants,  and  their  continuance 
devolving  upon  the  females,  they  did  not  employ 
them  with  as  much  diligence  and  assiduity  as  the 
case  required.  A  blister  was  afterwards  ap- 
plied to  the  wrist  and  another  to  the  ankle,  to 


51 

keep  up  the  irritation.     She  has  since  remained 
entirely  free  from  any  paralytic  affection." 

If  our  endeavours  to  restore  patients  by  these 
means  prove  unsuccessful,  we  are  by  no  means 
to  conclude  their  condition  hopeless.  On  the 
contrary,  it  will  be  proper  to  keep  up  a  constant 
excitement  both  by  the  internal  and  external  use 
of  stimulants.  The  internal,  most  generally  in 
use,  are  mustard  seed,  horse  radish,  ammonia, 
and  others  of  this  kind.  The  volatile  tincture 
of  guaiac  has  been  attended  with  great  advan- 
tage in  the  practice  of  Dr.  Hosack.  The  exter- 
nal are  horse  radish,  mustard,*  garlic,  blisters, 
Indication,  electricity,  (the  latter  being  some- 
times of  material  service,  and  frequently  attend- 
ed with  very  happy  effects,)  galvanism,  and  fric- 
tion, with  different  stimulating  liniments,  all  of 


'  The  external  application  of  mustard  seems  calculated  to 
do  much  good,aa  it  makes  a  very  powerful  impression  upon 
the  sy.:4cm,  and  creates  even  a  much  greater  degree  of  imi- 
tation than  Miatera.  See  Jackson's  Dissertation  on  Exter- 
nal Applications,  in  Caldwell's  Collection. 


52 

which  are  to  be  had  recourse  to  at  different 
times,  when  one  or  the  other  fails. 

The  operation  of  internal  stimulants  upon  the 
system  is  to  be  carefully  watched,  and  occasion- 
ally the  lancet  interposed  in  some  habits,  where 
there  is  a  great  disposition  to  the  regeneration 
of  plethora,  and  where  the  symptoms  of  it  are 
manifested,  otherwise  they  will  produce  the  very 
object  they  were  intended  to  obviate. 

Warm  bathing  is  often  an  important  auxiliary 
in  the  cure  of  paralysis ;  but  the  indiscriminate 
use  of  it  is  altogether  unjustifiable.  When  the 
disease  proceeds  from  a  plethoric  state  of  the 
system,  or  has  the  marks  of  plethora  without 
previous  blood  letting,  it  is  calculated  to  do 
much  injury  by  the  expansion  which  it  necessa- 
rily must  produce.  Its  principal  use  appears 
to  be  in  cases  from  worn-out  excitement,  as 
sometimes  occurs  in  the  advanced  stages  of  dis- 
ease :  but  it  should  never  be  used  without  the 
addition  of  brandy,  aq.  ammonia?,  or  some  other 
strong  stimulant.  The  cold  bath  in  some  cases 
where  it  can  be  borne,  is  very  useful,  as  by  its 


53 

stimulating  effects  it  imparts  tone  to  the  system, 
and  thus  removes  the  disease. 

Diaphoretics  form  a  valuable  class  of  reme- 
dies, and  may  be  administered  with  the  greatest 
benefit  in  every  stage  of  the  disease ;  but  differ- 
ent kinds  must  be  used  according  to  the  cause  of 
the  complaint. 

Exercise  is  a  very  important  remedy,  and  where 
it  is  not  altogether  impracticable,  it  should 
never  be  neglected.  Nothing  is  calculated  to 
restore  lost  action  to  paralyiiic  parts  sooner ;  as, 
in  addition  to  the  good  effects  of  motion,  per- 
spiration is  constantly  kept  up  by  the  excretory 
vessels  being  kept  in  a  pervious  state.  Flannel 
should  always  be  worn  next  the  skin. 

In  palsy  of  long  standing,  the  occasional  use 
of  blood  letting,  when  the  symptoms  of  plethora 
exist,  will  be  absolutely  necessary.  By  neglect- 
ing it  the  patient  will  be  threatened  with  the  most 
imminent  danger  of  being  carried  off  by  an  apo- 
plexy, or  complete  palsy.  A  case  of  hemiplegia, 
of  several  years  continuance,  was  under  my  care 
some  time  since,  where  Hie  overloaded  state  of 

Mi'-  blood  vessels  was  manifested  hv  numbness 

7 


54 

oppression  at  the  breast,  and  languor  of  the  in- 
tellectual powers:  by  blood  letting,  the  patient 
was  completely  relieved.  Had  I  improperly 
had  recourse  to  stimulants  in  this  case,  in  all  pro- 
bability, fatal  consequences  would  have  been 
produced. 

Palsy  from  debility,  seldom  or  never  occurs 
in  persons  in  good  health,  no  matter  at  what  age 
it  takes  place:  it  generally  arises  in  the  ad- 
vanced stages  of  disease,  when  the  excitement  of 
the  system  has  been  worn  out,  and  usually  ap- 
pears in  the  form  of  partial  paralysis.  It  also 
may  occur  in  persons  not,  affected  with  a  ful- 
ness of  the  vessels,  who  are  weak  and  languid, 
and  whose  digestive  powers  are  impaired,  in 
whom  blood  letting  might  be  productive  of 
injury.  In  these  cases,  by  restoring  tone  to 
the  system  by  means  of  nourishing  diet,  wine, 
porter,  iron,  and  other  tonics,  the  disease  may  be 
permanently  cured. 

It  remains,  lastly,  to  make  a  few  observations 
on  the  partial  palsies,  which  are  usually  con- 
fined to  the  head  and  extremities.  We  will, 
however,  mention  those  only  affect ing  the  optic 


55 

and  auditory  nerves,  both  of  which  are  sometimes 
produced  by  plethora.  The  first  is  divided  into 
two  kinds,  which  are  differently  named  accord- 
ing to  the  degrees  of  blindness  produced.  When 
there  is  a  diminution,  or  total  loss  of  sight,  the 
disease  is  called  amaurosis;  and  when  the  pow- 
ers of  vision  are  merely  deficient  at  night,  it  is 
called  nyctalopia.  That  plethora  produces  this 
disease,  it  is  reasonable  to  suppose  from  the 
anatomy  of  the  parts  involved  in  the  affection. 

The  only  difference  between  amaurosis  and 
nyctalopia  appears,  at  least  in  many  instances, 
to  be  in  the  degree  of  plethora  which  exists : 
in  the  former  it  is  so  great  as  completely  to 
paralyze  the  nerve,  and  render  it  insensible  to 
any  impression;  and  in  the  latter,  being  so  light 
as  not  to  impair  vision  during  the  day,  in  con- 
sequence of  the  stimulus  of  light,  more  than 
counterbalancing  the  effects  produced  by  the 
compression;  but  at  night  this  stimulus  being, 
in  a  great  measure,  withdrawn,  and  what  little 
there  is  being  disproportioned  to  the  pressure, 

i<  ii  '■,    I  >tally  obscured. 

The  treatment  "f  these  two  diseases,  when 


56 

arising  from  plethora,  consist  in  blood  letting* 
blistering,  purging,  small  alterative  doses  of  mer- 
cury, &c.  In  the  second  stage,  stimulants,  both 
general  and  local,  will  be  absolutely  necessary, 
Mr.  Ware  mentions  the  Cayenne  pepper  as  $ 
powerful  stimulant  in  such  cases. 

The  following  case  points  out  the  utility  of 
blood  letting  in  nyctalopia. 

Betsey  Bowers,  aged  thirty-four,  had  nycta- 
lopia for  some  time,  in  consequence,  no  doubts 
of  the  retention  of  her  menstrual  discharge,  as; 
she   was   not  afflicted   in  this   manner   before. 
Being   of  a  delicate  habit  of  body,  and   her 
pulse  natural,  there  were  apparently  no  symp- 
toms which  called  for  the  lancet;  but  supposing 
her  loss  of  sight  to  arise  from  pressure  on  the 
nerve,  in  consequence  of  the  plethora  of  the 
vessels  of  the  part,  I  bled  her  largely,  and  ap- 
plied  blisters    behind   her   ears.       From    this 
treatment   she    received    signal    relief,    as    vi- 
sion at  night  began  to  be  more  distinct.     She 
continued  to  see  alternately  better  and  worses 
but   relapsing   entirely,  or  nearly  so,  she  was 
again  bled.     The  relaxation  produced  by  the 


57 

blood  letting,  brought  on  a  profuse  flow  of  her 
menses,  and  after  this  evacuation,  she  could  see 
as  well  as  previously  to  her  attack.  This  affec- 
tion of  her  vision  continued  nearly  four  weeks, 
when  she  again  relapsed ;  but  on  the  re-appear- 
ance of  her  menses,  her  sight  was  again  restored, 
and  has  since  remained  good. 

This  practice  does  not  accord  with  the  recom- 
mendation of  Dr.  Thomas.  "Evacuation,"  he 
observes,  "  both  by  bleeding  and  purging,  has 
been  recommended  by  such  writers  as  have  ta- 
ken notice  of  this  disorder;  but  as  it  is  suppos- 
ed to  depend  upon  a  relaxed  state  of  the  optic 
nerves,  or  retina,  these  remedies  appear  to  be  im- 
proper, and  those  we  employ  ought  to  be 
such  as  will  strengthen  the  tone  of  the  parts." 
That  it  may  sometimes  depend  upon  the  relax- 
ed state  of  the  nerve,  upon  pressure  by  tumours, 
and  the  like,  we  will  not  deny;  but  that  pletho- 
ra is  sometimes  the  cause,  the  above-mentioned 
pase  proves. 

Palsy  of  the  auditory  nerve  also  arises  from 
plethora,  as  is  proved  by  the  following  case  : 
Jam:  IV.a.mk,  aged  forty-six,  of  the  nervous 


58 

temperament,  was,  on  the  fourth  of  February 
last,  attacked  with  numbness  of  half  the  body. 
She  was  unable  to  raise  the  affected  arm  to  the 
top  of  her  head,  and  was  totally  deprived  of  the 
sense  of  hearing  on  that  side.  In  this  way  she 
continued  until  the  eighth,  when  consenting-  to 
be  bled,  I  took  away  a  large  quantity,  and  be- 
fore the  orifice  was  closed,  her  hearing  was  per- 
fectly restored.  Her  numbness  and  coldness, 
which  existed  without  relief  from  warm  applica- 
tions, were  soon  completely  cured,  and  she  has 
since  remained  well. 

Having  finished  our  observations  on  the  dis- 
eases of  old  age,  as  connected  with  a  plethoric 
State  of  the  system,  it  remains  only  to  make  a  few 
remarks  on  the  means  of  preventing  this  plethora, 
as  there  are  few  states  of  the  system  in  which 
irritability  is  so  troublesome.  "Plethora  oc- 
curs chiefly  in  the  luxurious  female  whose  pam- 
pered appetite  prepares  a  superabundance  of 
blood,  whose  distensiie  vessels  yield  with  little 
resistance,  and  whose  secretions  from  inactivity 
are  slow  and  inconsiderable.  The  lax  habits, 
which  in  weak  resistance  approach  the  female, 


59 


equally  suffer,  and  the  phlegmatic  temperaments 
are  also  over  w  helmed  by  a  load  of  fluids."*    The 
pulse  frequently  gives  an  imperfect  idea  of  the 
cause.   It  is  often  apparently  weak;  but  by  hav- 
ing recourse  to  the  method  recommended  by 
Mr.  Brom field,  as  before  mentioned,  we  may 
frequently  detect  it.     When  this  fails,  our  opi- 
nion is  to  be  formed  from  other  circumstance's. 
"To   relieve   plethora,"  the  learned  Dr.  Parr 
observes,    "is  very  difficult;    bleeding,   some- 
limes  attended  with  a  little  temporary  relief,  is 
occasionally  followed  by  fainting;  and  after  a 
little  time  the   former  fulness,  and  the  debililv 
with  the  irritability  are  increased.     Evacuations 
by  stool,  and  a  more  feeble  diet  occasion  faint- 
ness,  and  exercise   produces  great  fatigue.     No 
other  plans,  however,  will  succeed,  and  each  must 
be  used  in  such  a  gradual  guarded  manner,  as  to 
prevent  uneasiness.    At  first  a  meal  may  be  lea- 
ned, soon  after  abridged.     A  feeble  diet,  fee- 
ble in  ii-  alimentary  powers, must  be  slowly  sub- 
Lituted;  and  Lhe  exercise,  at  firs!  in  a  carriage. 


• 


60 


must  afterwards  be  supplied  by  the  horse.  After" 
the  vessels  have  been  in  part  emptied  in  this  way, 
tonics,  or  the  cold  bath  may  be  safely  used." 

I  shall  conclude  by  again  adverting  to  the 
propriety,  utility,  and  absolute  necessity  of  blood 
letting  in  the  diseases  of  advanced  life  when  con- 
nected with  plethora.  Experience  has  again  and 
again  taught  us,  that  numerous  diseases  of  this 
period  of  life  are  relieved  by  it,  and  therefore 
we  have  no  hesitation  in  recommending  it. 
"I  have  nothing  to  say  upon  the  diseases  of 
old  people,"  says  Dr.  Rush,  "  but  what  is  to  be 
found  in  most,  of  our  books  of  medicine,  except 
to  recommend  bleeding  in  those  of  them  which 
are  attended  with  plethora,  and  an  inflammatory 
action  in  the  pulse.5'  "  Experience  proves  it  to 
be  more  necessary  under  equal  circumstances 
in  that  stage  of  life  than  in  any  other."* 


*  For  some  very  valuable  remarks  on  the  plethora  of  ad- 
vanced life  the  excellent  Inaugural  Dissertation  of  Dr.  Dyck- 
man,  on  the  Human  Fluids,  may  be  consulted  with  advantage; 


FINIS, 


Date  Due 

<f> 

Sc2 


on  t   e 


